GPEI Report: Poliomyelitis: intensification of the global eradication initiative

Report: Poliomyelitis: intensification of the global eradication initiative
EXECUTIVE BOARD EB134/35, 134th session 13 December 2013, Provisional agenda item 10.4

1.The Polio Eradication and Endgame Strategic Plan 2013–20181 was prepared in response to a request by the Health Assembly in resolution WHA65.5 on poliomyelitis: intensification of the global eradication initiative. In May 2013, the Plan was presented to the Sixty-sixth World Health Assembly. The present report summarizes the status of each of the four objectives of the Endgame Strategic Plan, the impediments to achieving the milestones in a timely manner, the current financing situation, and the programme priorities for 2014:

2. As of 10 December 2013, the number of cases of disease due to wild poliovirus had increased by 68% compared to the same time in 2012 (359 cases compared with 213 cases), with eight countries reporting cases of poliomyelitis compared to four at this point in 2012. This increase is driven by disease outbreaks due to new international spread of polioviruses from Nigeria into the Horn of Africa (183 cases in Somalia, 14 in Kenya, 6 in Ethiopia) and from Pakistan into the Middle East (17 cases in the Syrian Arab Republic). Four cases due to an imported poliovirus have also been detected in Cameroon. To date, cases of endemic poliomyelitis increased by 32% in Pakistan (to 74) compared with the same time in 2012. In the other two countries where the virus is endemic, Nigeria and Afghanistan, cases declined by 58% and 68%, respectively. In 2013, all cases detected in Afghanistan occurred in the Eastern Region and were due to polioviruses that originated in Pakistan. Wild poliovirus of Pakistani origin was also detected in environmental samples collected in Israel and the occupied Palestinian territory.

3. For the first time in the history of the eradication initiative, in 2013 all cases of poliomyelitis caused by a wild virus were due to a single serotype, type 1; the most recent case due to wild poliovirus type 3 occurred on 10 November 2012 in Nigeria. Cases due to circulating vaccine-derived poliovirus type 2 (57 cases in seven countries) declined by 16% compared to 2012, with most cases being either in Pakistan or the border area of Cameroon, Chad, Niger and Nigeria…

16. As of 25 November 2013, the major risks to attaining the 2014 eradication target of the Endgame Plan were: the bans on immunization campaigns in the North Waziristan agency in Pakistan and parts of southern and central Somalia; the continued targeting of vaccinators in Khyber Pakhtunkhwa province in Pakistan; ongoing military operations in Khyber Agency (within the Federally Administered Tribal Areas region) of Pakistan; insecurity in Eastern Region, Afghanistan and Borno, Nigeria; active conflict in the Syrian Arab Republic and chronic gaps in programme performance in Kano state, Nigeria. These risks to the vaccination of children in known polio-affected areas are compounded by gaps in polio surveillance and the continued threat of new international spread of wild poliovirus into highly vulnerable areas and populations.

17. Management of these risks requires full national ownership of the eradication programme in all infected countries, with deep engagement of all relevant line ministries and departments, and the holding of local authorities fully accountable for the quality of activities, particularly in accessible areas such as Kano. Accessing and vaccinating children in insecure and conflict-affected areas will in addition require the full engagement of relevant international bodies, religious leaders and other actors with influence in such settings. Collaboration with broader humanitarian efforts must be enhanced to develop and implement area-specific operational plans, generate greater community demand and participation, and adapt or modify eradication approaches in line with local contexts. In order to minimize the risks and consequences of international spread of poliovirus, Member States are urged to enhance surveillance, strengthen routine immunization coverage, and, where appropriate, implement supplementary immunization activities. The Secretariat will convene an expert group in 2014 to advise on further measures to vaccinate travellers from areas where there is active poliovirus transmission.

18. In order to facilitate the withdrawal of the type 2 component of oral polio vaccine in 2016, and further reduce global vulnerability to the remaining wild poliovirus serotypes, Member States are encouraged to establish plans for the introduction of at least one dose of the inactivated poliovirus vaccine into their routine immunization programmes. Recognizing the complex financing arrangements and tight supply timelines for introduction of this vaccine globally, the Strategic Advisory Group of Experts on immunization recommended that countries endemic and at high risk of polio develop by mid-2014 a plan for inactivated polio vaccine introduction, and that all countries develop such plans by the end of 2014.1

19.  In order to further strengthen governance and oversight of the eradication initiative, the Polio Oversight Board, comprised of the heads of the five core partners, initiated in-person meetings on a six-monthly basis, is adopting a systematic risk review process, and is introducing a decision-making process that facilitates more systematic input by donors and stakeholders. Within WHO, the Director-General established a cross-cluster Polio Endgame Management Team to enhance organizational support for programme management, strategy implementation, and resource mobilization and management.

Update: Polio this week – As of 9 January 2014
Global Polio Eradication Initiative
Full report:
[Editor’s extract and bolded text]
:: India will reach a great milestone in polio eradication on 13 January – three years since its last case of wild poliovirus! India was once thought to be the most difficult country in which to achieve polio eradication.
:: The Executive Board (EB) will meet in Geneva on 20-25 January. Ahead of the EB 134th session, the Global Polio Eradication Initiative (GPEI) published the report: “Poliomyelitis: intensification of the global eradication initiative”. The full report is available in English and French here. [excerpts above]
:: One new wild poliovirus type 1 (WPV1) case was reported in the past week. The total number of WPV1 cases for 2013 is now 12. The most recent WPV1 case had onset of paralysis on 11 December from Nad-e-Ali, Hilmand province. This is the first case reported from the southern part of the country in 2013. All other WPV1 cases are reported from Eastern Region, close to the Pakistan border.
:: One new cVDPV2 case was reported in the past week. The total number of cVDPV2 cases for 2013 is now 2. The most recent cVDPV case had onset of paralysis on 6 November (from Konduga, Borno)
:: Two new WPV1 cases were reported in the past week. One from South Waziristan, FATA and one from Gulshan Iqbal Karachi, Sindh. The total number of WPV1 cases for Pakistan in 2013 is now 85. The most recent WPV1 case had onset of paralysis on 16 December (from South Waziristan, FATA)

    Rotary said its members worldwide are “celebrating a major milestone in the global effort to eradicate polio: India, until recently an epicenter of the wild poliovirus, will mark the third anniversary of its last recorded case of the paralyzing infectious disease on 13 January.”
…In celebration of the decades-long battle and ultimate victory over this disabling disease in India, Rotary clubs throughout the country will illuminate landmarks and iconic structures on Jan. 13.  India Gate in Delhi and Red Fort in Delhi and Agra are among the structures that will carry Rotary’s dramatic message – ‘India is Polio Free’. Rotary said the three-year achievement also sets the stage for the polio-free certification of the entire South East Asia Region of the World Health Organization in the first quarter of 2014 by the Regional Certification Committee. The Indian government also plans to convene a polio summit in February to mark the occasion. Rotary said the challenge now is to replicate India’s success in neighboring Pakistan (in a different WHO region), one of three remaining polio-endemic countries including Afghanistan and Nigeria…
Media Release: EVANSTON, Ill., Jan. 10, 2014 /PRNewswire-USNewswire/ —